Poor Flow-Mediated Dilation of Brachial Artery in Heart Transplant Recipients is Associated with Severity of Transplant Coronary Arterial Vasculopathy

Abstract

Introduction: Periodic leg movements during sleep (PLM), regularly recurring movements of the legs during sleep, cause frequent arousal and intermittent eleva- tions of blood pressure and heart rate. One study showed that PLM disorder (PLMD) was associated with increased mortality in patients with chronic heart fail- ure. However, clinical significance of PLMD in hospitalized patients following acute decompensated heart failure (ADHF) remains unknown. Methods: After the initial improvement of acute signs and symptoms of ADHF, we performed polysomnogra- phy on consecutive patients who were left ventricular ejection fraction (LVEF) ! 50%, and were hospitalized due to ADHF between 2012 and 2014. PLMD was defined as PLM index S 25 that we thought was moderate-to-severe PLM. The risks for composite of all-cause mortality and re-hospitalization, were assessed by stepwise multivariable Cox proportional model including variables showing P!0.15 in univar- iate analyses. Results: Overall, 94 patients were enrolled. PLMD was found in 24 patients (26%). At a median follow-up of 5.2 months, 30 patients had an episode of rehospitalization and/or death (32%). In the multivariable analysis, presence of PLMD was significantly associated with increased risk of rehospitalization and/or mortality (hazard ratio, 2.34; P50.024) independent from hemoglobin level and severity of sleep disordered breathing. Conclusion: Presence of PLMD was indepen- dently associated with increased risk of rehospitalization and/or mortality even in hospitalized patient following ADHF.